Two months after the governor “reopened” Oregon, lifting mask and other pandemic-related orders, Lincoln County’s hospitals found themselves pushed to the limit by the delta variant with 23 COVID inpatients during August, and public health workers found themselves underwater, flooded with more than double the cases to investigate than during the previous highest month.
Other regions of the state, particularly in southern Oregon and notably with lower vaccination rates, have been hit harder during the mid-summer surge, but Lincoln County has still contended with many more total cases and more severe disease than at any previous time during the pandemic.
Lincoln County Public Health Director Florence Pourtal told the Lincoln County Board of Commissioners during its meeting Sept. 1 there were 786 COVID cases the previous month — 260 percent higher than during June 2020 and an almost 800 percent increase over July.
“And those were the cases that have been reported to us,” Pourtal said, not those who might have been ill but not tested, or who had taken an at-home test without reporting the results to the health department. Local testing positivity is also at a whopping 28.3 percent, six times what’s considered optimal, an indicator that many cases are going undetected.
“Our incidence rate is through the roof at 619 per 100,000,” Pourtal said. “As a reminder, when we were in extreme risk, the threshold was 200 new cases per 100,000.”
Pourtal said there were 282 new cases the previous week, an increase of 37.5 percent (that follows weekly increases of 40 and 70 percent).
COVID hospitalizations tripled from the previous month. Of the 23 COVID inpatients at Samaritan Pacific Communities Hospital and Samaritan North Lincoln Hospital during August — all county residents, Pourtal said — 83 percent were unvaccinated.
It’s not clear how many total county residents were hospitalized during August, as some were treated in hospitals in other counties, where three died.
There have been five COVID-related deaths reported during August, though the Oregon Health Authority has yet to release the age, positive test and death date for two of those people. The deadliest month in Lincoln County for COVID was July 2020, when seven residents of a skilled nursing facility in Newport died during an outbreak in which 51 tested positive, including staff.
Local COVID hospitalizations peaked on Aug. 26, when there were 10 patients between the two hospitals and six in the Newport intensive care unit, that ICU’s upper limit. Samaritan’s Newport hospital has a capacity of 25 inpatients total, with either five or six ICU beds, depending on staffing. The Lincoln City hospital’s capacity is 16 total inpatients, four in the ICU.
Hospital census fluctuates often, and capacity depends on factors beyond the ratio of patients to beds. The number of hospitalized COVID patients dropped to five by the time of Wednesday’s meeting, Pourtal said, but there was yet another challenge — the ICU in Lincoln City was unable to accept any patients at that time because it could not be staffed. That’s the second time Pourtal has reported that condition in recent weeks.
Dr. Lesley Ogden, CEO of Samaritan’s two coastal hospitals, told YachatsNews the health system was working to address the staff shortage. She said staffing was a national issue with multiple factors at play, including an aging workforce, a dearth of new nursing school graduates and attrition related to the pandemic.
Regarding the Lincoln City ICU unit, Ogden explained the required nurse-to-patient ratio in intensive care was one to two, compared to one to four in a regular unit.
“We are making day-by-day decisions based on staffing, and our intent is to fill these positions with permanent ICU nurses. We just need time to do it,” she said. “As federally-designated critical access hospitals, we are charged with improving access to health care by keeping essential services in rural communities, and we fully intend to meet that obligation.”
Health department staff has also been strained in its efforts to track and contain spread, and since the latest surge began, has added the equivalent of 14 full-time COVID workers.
Prior to the surge that began with the emergent dominance of the highly contagious delta variant in July, there were two full-time equivalents for case investigations, two vaccine clinic coordinators and two outreach staff, Pourtal told the board. There are now eight full-time equivalents for case investigations, six for contact tracing (with some health from the Oregon Health Authority), four full-time clinic positions and two outreach staff.
Each interview with a positive person takes about 40 minutes, Pourtal said — that’s 524 total hours just for August’s cases.
While it seemed as if the county might see some relief from the epidemic’s growth, with just eight new cases reported Aug. 31, the next day’s figure belied that trend, with 53 new positive results. “What can we do to stop the spread — same message, but I will keep on repeating it. Number one, get vaccinated,” Pourtal said. “The main tool in the toolbox to protect you against this disease, especially a severe iteration of the disease and hospitalization and possibly death.”
Pourtal said wearing a mask in public — as Gov. Kate Brown has again ordered in both indoor and outdoor settings — was also critical to protecting those who cannot be vaccinated, including children under 12, who are infected by the delta mutant at a greater rate than previous variants and will to go back into classrooms next week.
Pourtal said there has been a slight increase in local vaccine uptake, with an average of 107 daily doses the week preceding Aug. 29, a 30 percent rise from the previous week. More than 77 percent of county residents ages 12 and older received at least one shot as of Aug. 30, Pourtal said.
The health department director said the vaccine was in plentiful supply at local pharmacies, primary care providers and clinics. Public health has 11 clinics scheduled during the next two weeks, including: Sept. 4 at Lincoln City Outlet Mall, Sept. 5 in Nashville, Sept. 7 at Eddyville Charter School, Sept. 8 at Rogue in Newport, Sept. 9 at Coastal Phoenix Rising in Lincoln City, Sept. 11 at Lincoln City Community Center, Sept. 13 at the Sea Note in Yachats, Sept. 14 at Oregon Coast Community College in Newport, Sept. 15 at Lincoln County Parole and Probation in Newport, Sept. 16 at Oregon Coast Community College in Lincoln City and Sept. 17 at La Juquilita in Newport.
All three vaccines will be available at all locations. For specific times and addresses and to sign up, visit the county website at co.lincoln.or.us/hhs/page/covid-19-vaccination-clinics. Walk-ins are welcome depending on availability.
Pourtal said the Oregon Health Authority reported 114 cumulative breakthrough cases — positive COVID tests of fully vaccinated people — since the agency began surveillance of such occurrences, overwhelmingly during July. There have been 993 total cases in the county since vaccines became widely available to the public, a breakthrough case rate of 11.5 percent.